Building the case for food as prevention

The term "prescription produce" conjures images of doctors scribbling scripts for apples and carrots, but it has come to refer more broadly to efforts to improve access to healthy food. We must build evidence for and expand those efforts.


In his book How Not to Die, plant-based physician Michael Greger highlights the disconnect between nutrition research and medical education:

Most deaths in the United States are preventable, and they are related to what we eat. Our diet is the number-one cause of premature death and the number-one cause of disability. Surely, diet must also be the number-one thing taught in medical schools, right?

Sadly, it’s not. According to the most recent national survey, only a quarter of medical schools offer a single course in nutrition, down from 37 percent thirty years ago.

The same can be said of our approach to healthcare. Surely, diet must be our number-one means of preventing disease, right? Sadly, despite the abundance of evidence supporting the disease-preventing benefits of healthy eating, it’s not. Surely, employers, insurance companies and healthcare providers must be making nutritious foods more accessible to promote health and reduce spending, right? Sadly, they aren’t—at least not nearly as much as they could be.

However, this failure to focus on “food as prevention” isn’t surprising given the lack of real-world evidence around its cost savings impact. To harness the disease-preventing potential of healthy eating and rein in healthcare spending, we must build that evidence.

Prescription produce is a promising approach but still lacks robust real-world evidence and, more importantly, taps into only a fraction of the potential of “food as prevention.” A study published in PLOS Medicine found that "health insurance coverage for healthy food could improve health, reduce healthcare costs, and be highly cost-effective after five years." However, this study used theoretical models—no patients were actually offered 30 percent subsidies on healthy foods—so while the projected cost savings are impressive, they aren't convincing enough for actual payers (such as employers and health insurers) to take action.

To create a convincing case, efforts like these must be made in the real world. Fortunately, nonprofits have been doing just that with initiatives like Double Up Food Bucks, through which SNAP recipients' food dollars double in value when used to purchase local produce. But these efforts tend to emphasize reach over return on investment (ROI) and, like simulation studies, don't provide the evidence necessary for payers to embrace prescription produce. Given the lack of real-world data derived from academic efforts and the limited economic emphasis and scalability of nonprofit efforts, business must step up to build the ROI case for food as prevention and accelerate its adoption.